Figure 1. Pedunculated black conjunctival mass at superior nasal limbus of right eye of a 76-year-old white woman, who had undergone excision of a smaller pigmented tumor 10 years previously that histopathologically was a malignant melanoma in juxtaposition to a benign-appearing nevus. A similar clinical appearance may occur with a tumor of de novo origin. From Brownstein S, Henry M, Bernardo AI. Malignant melanoma of the conjunctiva after 11 years. Can J Ophthalmol. 1979;14:142-146. Reprinted with permission of the Canadian Journal of Ophthalmology.

Figure 2. (A) Extensive PAM of the bulbar, forniceal, and palpebral conjunctiva of the right eye in a 58-year-old white woman. (B) The same patient after 1 year of intermittent topical mitomycin C therapy resulting in the conjunctiva becoming free of melanin pigment and in subsequent map biopsies showing no atypical melanocytes. From Yuen VH, Jordan DR, Brownstein S, et al. Topical mitomycin treatment for primary acquired melanosis of the conjunctiva. Ophthalmic Plast Reconstr Surg. 2003;19:149-151. Reprinted with permission.

Figure 3. Extensive patches of PAM of the palpebral and bulbar conjunctiva of the left eye with focal pigmented nodules (arrow) in a 28-year-old white woman. From Jakobiec FA, Brownstein S, Wilkinson RD, et al. Combined surgery and cryotherapy for diffuse malignant melanoma of the conjunctiva. Arch Ophthalmol. 1980;98:1390-1396. Copyrighted © 1980, American Medical Association. All rights reserved.

Figure 4. Conjunctival malignant melanoma in a 71-year-old white man with metastases to the preauricular region (P). Courtesy of Dr. J. A. Shields.

Figure 5. Histopathologic section from a patient with PAM with atypia of the conjunctiva (same patient as in Figure 3) shows prominent nests of atypical melanocytes in the junctional region with pagetoid invasion (arrows) of the overlying epithelium (hematoxylin and eosin, x 250).

Figure 6. Histopathologic section shows epithelioid melanoma cells in the junctional region of the conjunctiva with pagetoid invasion (arrows) of the overlying epithelium (hematoxylin and eosin, x 400). From Jakobiec FA, Brownstein S, Wilkinson RD, et al. Adjuvant cryotherapy for focal nodular melanoma of the conjunctiva. Arch Ophthalmol. 1982;100:115-118. Copyrighted © 1982, American Medical Association. All rights reserved.

Figure 7. Histopathologic section of a recurrent malignant melanoma of the superior forniceal conjunctiva shows a large cluster of epithelioid cells with an atypical mitosis (arrow) in the substantia propria (hematoxylin and eosin, x 1000).

Figure 8. Histopathologic section of superior palpebral conjunctiva (taken from a dark brown nodule depicted by the arrow in Figure 3) shows PAM with atypia and invasive malignant melanoma of the adjacent substantia propria (hematoxylin and eosin, x 250).

Figure 9. A 69-year-old white man who 2 years earlier underwent excision and cryotherapy of a bulbar conjunctival malignant melanoma located inferonasally on the right eye with the subsequent development of an epibulbar recurrence and a pigmented eyelid margin nodule. The latter was found to be an in transit intralymphatic metastasis from the epibulbar tumor, as histopathologic examination of a full thickness eyelid excision showed no intraepithelial melanocytic involvement overlying the nodule of tumor, which was present in the dermis and orbicularis muscle. Regional metastases to the preauricular and cervical lymph nodes subsequently occurred and was managed with radical neck dissection and parotidectomy. From Jakobiec FA, Rini FJ, Fraunfelder FT, et al. Cryotherapy for conjunctival primary acquired melanosis and malignant melanoma: experience with 62 cases. Ophthalmology. 1988;95:1058-1070. Reprinted with permission from the American Academy of Ophthalmology.